Normally health insurance companies will only allow you to apply for individual health insurance during the annual “Open Enrollment”. However, the Affordable Care Act still permits you to apply for new major medical coverage under certain special circumstances. Here is a list of the main “qualifying life events” which would allow someone to apply for health insurance after the open enrollment has ended: birth/adoption of a child, marriage, divorce, death of a dependent policyholder, loss of previous employer-sponsored health insurance coverage, exhaustion of COBRA insurance, or loss of eligibility for CHIP or Medicaid.

Additional reasons include: gaining status as a citizen, national or legally present individual, loss of coverage due to a permanent move outside of your plan’s coverage area, termination of a short-term (temporary) health plan, or change in income that affects eligibility for premium tax credits for Marketplace enrollment only.

Penalties for not having a “qualified” health plan for at least 9 months in a calendar year, will be assessed based on the number of months one is not insured with a qualified major medical plan. You can minimize or prevent this penalty depending on how many months you maintain at least the minimum essential coverage.

Based on adjusted gross household income, some low/middle-income applicants may be eligible for savings on their health insurance premiums, by applying through the Health Insurance Marketplace. To be eligible for consideration, an individual’s gross adjusted household income must be between 100% – 400% of the Federal Poverty Level (FPL). Even if they do not qualify for a premium tax credit, they could still apply for an “Off-Marketplace” regular ACA-Compliant health plan, without financial assistance.

Most insurance companies offer traditional qualified PPO plans, but rates are generally higher than last year. If having a moreaffordable health plan is a priority, many insurance companies also have HMO health plans available at lower rates. HMO plans are still qualified major medical insurance, but they have certain Network restrictions.

You can get answers about health insurance questions by contacting a licensed independent health insurance agentat AustinHealthPlans.com. There are never any fees for quotes or other services. An agent will assist you in choosing an appropriate, affordable health plan and help with the completion of your application.

Contact us at: tom@austinhealthplans.com or call (512)535-3556 and let us know how we can help you. We are “Tejas” friendly and serve clients throughout the entire state!

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About tcdiehl

I have been an independent insurance agent licensed in Texas since 2003. My focus is providing affordable insurance coverage through multiple reputable insurance providers for individuals, families, and small groups. I can also help with Medicare insurance needs.
Allow me to connect you with the appropriate health, life, disability, long term care, and/or dental plan(s) based on your health, personal, and financial needs.
Call me at (512) 535-3556, E-mail: tom@austinhealthplans.com.